British actor Hugh Laurie, a gifted amateur athlete whose natural speaking voice recalls his old school Eton, has been nominated in this year’s Emmy Awards for his role as a snaky New Jersey doctor with a half-destroyed leg. Many will remember Laurie playing an assortment of pompous twits alongside Rowan Atkinson in Blackadder, but the role most vividly brought to mind by his performance as the damaged Dr Gregory House is his minor part in the 1995 movie version of Sense and Sensibility. There he played the misanthropic Mr Palmer, whose chattering dimwit wife was the metaphorical equivalent of Dr House’s gammy leg – a constant source of irritation and a heavy lifelong burden – and whose eye-rolling filthiness of temper likewise masked a deeply buried warmth of heart. Never mind that Sense and Sensibility is set two centuries earlier; some things never change.

In House (Channel Ten, Wednesdays, 8.30 p.m.) Laurie plays a specialist in infectious diseases, constantly crossing verbal swords with hospital administrator and worthy opponent Dr Lisa Cuddy, and relying on his oncologist friend Dr James Wilson for a bit of down-time company. He has at his disposal a team of bright young medical things whose job is to do his bidding. House belongs neither to the “realist” mode of ER nor to the “reality” genre of RPA. Its conventions are those of the one-hour, problem-solving medical drama, and it combines character-driven dialogue with clue-puzzle plots to make witty, imaginative use of this well-established TV genre. As with a detective novel – or indeed a sonnet, a sonata or a landscape painting – the show’s quality lies not in the avoidance of the genre’s rules and conventions but in the skill and originality with which they are followed and used.

Scriptwriter David Shore, also a member of the executive production team, is clearly a connoisseur of detective fiction. To fans of the Sherlock Holmes books it’s obvious that Dr House’s diagnostic skills have been shamelessly poached – “You know my methods, Watson” – in an act of homage to Sir Arthur Conan Doyle. In the pilot episode, a man complaining of back spasms is informed by House that his wife is having an affair. How does he know this? From the man’s complexion, which is the very strange colour one goes when on an over-healthy diet of carrots and other sources of beta-carotene. “You’re ORANGE, you moron. And it’s one thing for you not to notice, but if your wife hasn’t picked up on the fact that her husband has changed colour she’s just not paying attention.”

We don’t yet know what Dr House used to be like before “muscle death” left him reliant on Vicodin and a walking stick, but the sharp tongue and zero tolerance for fools have probably been with him from birth. Laurie is a superb actor, able to register tiny glimpses of his whip-tongued character’s hidden, abstract tenderness for the human race while keeping to a minimum the awful American “Aaawww” factor – though the episode about sick babies did teeter on the sentimental brink. A central part of his character’s motivation is the idea that patients might have limited confidence in a doctor who is himself so visibly damaged. “People don’t want a sick doctor,” he says to his friend Wilson, who replies: “That’s fair enough; I don’t like healthy patients.”

Laurie’s prominent blue eyes and long, horsy English face make him seem almost a different species from the rest of the regular cast, who are pretty boys to a man except for the two pretty women. Robert Sean Leonard, who played the pink-cheeked, silver-tailed adolescent suicide in Dead Poets Society, seems to be having much more fun here as the oncologist Wilson, deftly playing off Laurie and delivering his wry one-liners with relish. Australian actor Jesse Spencer plays “intensivist” Dr Robert Chase, his beautifully ordinary Australian voice a tonic amid this gaggle of American accents. Spencer’s Botticelli-angel face has in the past landed him onstage roles as both Christopher Robin and Peter Pan, so the splashes of blood and vomit on this show must be quite bracing. And Omar Epps, as the ex-gangsta-turned-neurologist Dr Eric Foreman, has the softest features and sweetest expression of the lot. The women are Jennifer Morrison as immunologist Dr Allison Cameron, a pretty girl with a nasty past who has so far come across as a bit wet and drippy, and the wonderful Lisa Edelstein as Cuddy, strongly reminiscent of Sex and the City’s Sarah Jessica Parker: same petite and piquant presence, same smart mouth, same mannerisms, same charisma.

Based around these six regulars, each episode is a clever mixture of conversations and subplots in the course of which they gradually thrash out a diagnosis, usually featuring at least one of the staple brainstorm-with-the-whiteboard scenes you see in the incident rooms of TV’s police procedurals. These ensemble scenes exemplify the good balance among the show’s four cornerstones: medical information, entertaining repartee, House’s character and the pushing forward of the plot, as in exchanges like this:

FOREMAN: A tuberculoma doesn’t give you a temperature of 105.

CHASE: Then it’s a tuberculoma and something else.

WILSON: The “something else” is going to melt her brain.

HOUSE: Poach. Better metaphor.

What with the infinite number of combinations of things that can go wrong with you and treatments that can either fix them or make more things go wrong with you – or both – the House plots have the ineffable elegance of algebra. They don’t even try to be “realistic” in the sense of “probable”. One of the other things this show brings home is the vast cast of extras a diagnosis can involve: not only your biological parents and all the sexual partners you’ve ever had, but a careless pharmacist, a medical student wearing an unclipped tie dangling in an unsterilised sink and a hospital volunteer who handles the gift-shop teddy bears with the same hand she’s just used to wipe her nose.

Bryan Singer’s direction is sophisticatedly pre-occupied with composition and aesthetics from shot to shot, another way of distancing viewer expectations from realism’s – much less reality’s – untidiness and lack of closure. This is apparent from the opening scene of the pilot episode, in which a pretty girl in an urban landscape runs through a tunnel of cyclone fencing-wire whose geometry surrounds and entraps her. This placement of breathing, moving human bodies against the coldly regular shapes of enclosures, operating theatres, wards, machines and hospital beds is the show’s signature aesthetic, insistently reminding viewers of the dynamics of human life. Any unconscious or dead body is eerily lined up in the shot to become part of its geometry, like a Leonardo drawing. The message seems to be that where there’s life, there’s hope: any living body keeps shifting the composition to make a new pattern.

Singer particularly likes overhead shots, which make the symmetry of hospital machines and equipment even more apparent. There are trick shots, like the tread pattern on the soles of House’s shoes in a close-up so tight that it disorients and alienates the viewer, who for a moment has no idea what it is until the camera pans back to reveal House with his feet up on the desk. There are lots of microscopic views of interior events – cameras up noses and down throats, computer-graphic renditions of tiny but crucial bodily events at cell level. Stomach-churning medical stuff is shown in shots composed so as to give it a bizarre abstract beauty: the scalpel at the throat, the needle in the eye, the shining chips of bone as the drill bores into the skull beneath the skin.

There are also a few undeniable and unredeemable ick factors, from the occasional leak of treacle in the script to the gratuitous close-ups of baby vomit. But in general House is much more than usually interesting, original and funny. Any show that uses the word “mnemonic” in the dialogue, an early Rickie Lee Jones classic in the soundtrack and the subplot of a boy with an MP3 player stuck up his backside has got to be worth watching.

British actor Hugh Laurie, a gifted amateur athlete whose natural speaking voice recalls his old school Eton, has been nominated in this year’s Emmy Awards for his role as a snaky New Jersey doctor with a half-destroyed leg. Many will remember Laurie playing an assortment of pompous twits alongside Rowan Atkinson in Blackadder, but the role most vividly brought to mind by his performance as the damaged Dr Gregory House is his minor part in the 1995 movie version of Sense and Sensibility. There he played the misanthropic Mr Palmer, whose chattering dimwit wife was the metaphorical equivalent of Dr House’s gammy leg – a constant source of irritation and a heavy lifelong burden – and whose eye-rolling filthiness of temper likewise masked a deeply buried warmth of heart. Never mind that Sense and Sensibility is set two centuries earlier;...